Covered began as a services business (fighting denials in exchange for a percent of what we recover) and has now developed a software product that we are licensing based on our experiences fighting denials and feedback from RCM professionals. Covered can generate appeal letters, and helps RCM specialists fight and prevent denials by layering AI on top of previously diverse and unconnected databases (medical policies, FDA guidelines, LCD's, etc.). This allows them to identify denial root causes, and is used pre-submission and post-denial. We have paying customers and have been around for nearly two years.

Waystar delivers innovative technology that simplifies and unifies healthcare payments. The company’s cloud-based platform helps healthcare providers across all care settings streamline workflows, improve financial performance and bring more transparency to the patient financial experience. Waystar solutions have been named Best in KLAS or Category Leader by KLAS Research 16 times (across multiple product categories) and earned multiple #1 rankings from Black Book. The Waystar platform is used by more than half a million providers, 1,000 health systems and hospitals, and 5,000 payers and health plans—and integrates with all major hospital information and practice management systems. On an annual basis, Waystar’s AI-powered solutions process $5B in patient payments, generate $4B in out-of-pocket estimates and process claims representing approximately 40% of the U.S. patient population. For more information, visit www.waystar.com.

Denial Prevention tools: Approximately 50% of denials can be prevented, but even if you send "cleaner claims", you’re beholden to the next algorithm shift that (often incorrectly) automates denials. What about the 50% that are not preventable, where you've done everything right? 

Incumbent RCM software companies: Move slowly, denials not a core focus area, and with older solutions, the tech is not easy to use or modern. Our sole focus is excellence in the prevention and addressing of denials. 

New Entrants / Direct Competitors: Very new, and in a fragmented physician market, there are billions of dollars in denials to attack. Most importantly, while these are also based in AI/LLM's, our focus is on truth. What does the payer say they will cover, and how does that match up to what was done? This is a key differentiator.